In certain orthopaedic reconstruction procedures such as a semitendinosus gracilis composite graft or a mid-third patellar tendon graft, it is necessary to remove a piece of tendon from a patient's knee area. After the tendon has been removed, it is used to replace either the anterior or posterior cruciate ligament. These tendons and ligaments are illustrated in FIG. 1. The semitendinosus gracilis composite graft is illustrated as element 12, and the mid-third patellar tendon graft is illustrated as element 14. The anterior and posterior ligaments are illustrated as elements 16 and 18.
The anterior and posterior ligaments 16, 18 are generally cylindrical ligaments. Therefore, when tendon grafts are taken to reconstruct these cruciate ligaments, it is desirable for the grafts to be uniformly cylindrical. It is also important to be able to determine the precise diameter of the tendon graft as well as the length of the graft. It is necessary to know these dimensions in order to drill a tunnel 20 (FIG. 2) through a patient's tibia and fibula which approximates the diameter of the tendon graft.
It is important that the diameter of the tunnel 20 is well matched with the diameter of the tendon graft so that the tendon is securely imbedded when inserted in the tunnel. If the tunnel is too large, irritation of the tendon may occur. This irritation may particularly occur in the area where the tibia and fibula meet and rub against each other as a patient flexes his knee. It is also important to know the precise length of the tendon in order to determine the appropriate length of the tunnel to be created. It is necessary that this tunnel be positioned to produce the optimal isometric configuration to accommodate the harvested graft.
In the past, relatively awkward devices were used to measure the diameter of a tendon graft. These devices consisted of a series of cylindrical tubes that ranged in diameter from six to fourteen millimeters in one millimeter increments. Each of these tubes were approximately two inches in length. After a tendon graft had been harvested, the graft was forced into a tube to determine if the graft had the same diameter of the tube.
Many grafts did not have uniform diameters throughout the length of the graft. Therefore, it was possible to obtain a misreading of the diameter of the graft since a portion of the graft may appear to fit snugly within the tube and comply with the sizing tube. The tubes were awkward to work with because the tendon grafts are pliable and can be difficult to insert in a tube without deforming the graft. Therefore, a need existed to develop a single device which was relatively easy to handle and could easily measure the diameter of a tendon.
As discussed above, it is also important to be able to determine the precise length of a tendon graft. In the past, a separate device, such as a simple ruler, was used to measure the length of the graft. This required that medical personnel have both a series of measuring tubes and a separate measuring tape or ruler available in the operating room to size the diameter and measure the length of a graft.
After the size of the diameter and length of a graft has been determined, a plurality of sutures are generally inserted in each end of the graft. The sutures are used to pull the graft through the tunnel and position anchor screws 22 at each end of the graft after the graft has been located in the tunnel. Generally, three sutures are placed in each end of the graft to accomplish these tasks. It is desirable that these sutures be evenly distributed at each end of the graft. This is particularly important in a bone-to-bone, mid-third patellar procedure. In the past, it has been difficult to hold the end of a bone plug while the sutures were inserted in the graft without either accidentally dropping the graft or pricking the finger of the medical personnel holding the graft. Therefore, a need existed to develop a device which held the end of a graft in a fixed position while a series of sutures were being placed in the graft without deforming or dropping the graft.
The subject invention is a single device which meets all of the needs described above. In addition, the subject invention allows medical personnel to fixate, measure, size, and suture a tendon graft or bone plug without contaminating the graft or plug or exposing it to other damage.
Thus, it was a primary object of the subject invention to provide a device for easily determining the diameter of a tendon graft or bone plug.
It was also an object of the invention to provide a device for measuring the length of a tendon graft or bone plug.
It was still another object of the invention to provide a device which may maintain the end of a tendon graft or bone plug in a fixed position while a plurality of sutures are inserted therethrough.
It was yet another object of the invention to provide a single device which accomplishes each of the tasks described above and which is easy to manipulate by medical personnel.
Other objects and many of the attendant advantages of the subject invention will become apparent from the detailed description that follows with the accompanying drawings.